Associations Between Chronic Air Pollution and COVID-19 Mortality: A Patient-Level Analysis from New York City

BACKGROUND AND AIM: Vulnerability factors for COVID-19 mortality may include environmental exposures, such as air pollution. We aimed to perform individual-level analyses to understand whether, amongst adults hospitalized with PCR-confirmed COVID-19, higher chronic air pollution exposure is associated with risk for COVID-19 mortality, intensive care unit (ICU) admission or intubation. METHODS: We conducted a retrospective analysis of SARS-CoV-2 PCR positive patients admitted to seven New York City hospitals from March 8, 2020 to August 30, 2020. We estimated annual average fine particulate matter (PM2.5), nitrogen dioxide (NO2) and black carbon (BC) exposures at patients' residential address by leveraging the validated, spatiotemporal resolved NYC Community Air Survey. We employed multivariable quasipoisson regression with propensity score weighting to examine associations between chronic PM2.5, NO2 and BC exposure, considered separately, and COVID-19 outcomes. RESULTS:Of the 6,542 patients, 41% were female (N=2,936) and aged a median of 65 years (IQR 53, 77). Nearly 60% of the cohort self-identified as a person of color [Hispanic (26%), non-Hispanic Black (26%) or Asian (7%)]. Air pollution exposures by place of residence were generally low. Overall, 31% (N=2,044) of the cohort died, 19% (N=1,237) required ICU admission and 16% (1,051) required intubation and mechanical ventilation. In multivariable models, a 1µg/m3 increase in PM2.5 exposure was associated with a 11% increase in the risk of mortality (OR 1.11, 95% CI 1.01, 1.21) and 13% increase in the risk (RR 1.13, 95% CI 1.00, 1.29) of ICU admission. BC was positively, but not significantly, associated with COVID-19 outcomes in multivariable analyses. CONCLUSIONS:Higher chronic PM2.5 exposure is associated with increased COVID-19 mortality and ICU admission. Our data support of the urgency of environmental justice efforts in current and future public health pandemic responses. KEYWORDS: air pollution, COVID-19, mortality